Oncology & Hematology Coding Alert

Pembrolizumab

Indications: Pembrolizumab is used in metastatic NSCLC that expresses PD-L1 and whose disease progressed with or following platinum-containing chemotherapy. It is also used in lung cancer that has an abnormal “EGFR” or “ALK” gene and has not responded to EGFR or ALK inhibitors medications.

Another indication for pembrolizumab is advanced melanoma no longer good for surgical excision and not responding to ipilimumab. It is also used for ‘BRAF’ gene positive melanoma not responding to BRAF inhibitors.

Formulations, dosage and administration of pembrolizumab: Pembrolizumab is available as 50 mg lyophilized powder in single-use vial for injection after reconstitution and as 100 mg/4 mL (25 mg/mL) solution in a single-use vial for injection.

Pembrolizumab is administered by the intravenous (IV) route over a period of 30 minutes. The recommended dose is 2 mg/kg. It is usually given every 3 weeks. Your physician will decide the number of treatments the patient may need.

Ramuciruzumab

Formulations: Ramucirumab is available as single dose vials of 10 mg per ml in two strengths:

• 100 mg/10 mL (10 mg per mL) solution, and
• 500 mg/50 mL (10 mg per mL) solution.

Ramucirumab is administered by IV infusion.

Indications, dosage and administration:

Ramucirumab is used for:

• Advanced gastric or gastro-esophageal junction adenocarcinoma that has progressed despite fluoropyrimidine- or platinum-containing chemotherapy. It is used as a single agent or in combination with paclitaxel in dose of 8 mg/kg every 2 weeks.
• Metastatic non-small cell lung cancer that has not responded to treatment with platinum-based chemotherapy. It is used in combination with docetaxel in dose of 10 mg/kg intravenously on day 1 of a 21-day cycle prior to docetaxel infusion.
• Metastatic colorectal cancer with disease progression that has not responded to treatment with bevacizumab, oxaliplatin, and a fluoropyrimidine. It is administered in combination with standard chemotherapy in dose of 8 mg/kg intravenously every 2 weeks, prior to chemotherapy administration.

You can read more about prescribing information of Keytruda^® at http://www.merck.com/product/usa/pi_circulars/k/keytruda/keytruda_mg.pdf and of Cyramza^® at http://pi.lilly.com/us/cyramza-pi.pdf.